高度近视眼不同程度视盘倾斜患者临床特征分析

Analysis of clinical characteristics of high myopia patients with different degrees of optic disc tilt

目的 分析高度近视(HM)眼不同程度视盘倾斜患者的临床特征。方法 横断面研究。纳入2021年4月至12月在成都中医药大学附属医院就诊的HM患者60例120眼,依据用视盘椭圆指数(OI)衡量的视盘倾斜程度分为4组,无视盘倾斜(OI>0.80)组31眼,轻度视盘倾斜(OI为>0.75~0.80)组27眼,中度视盘倾斜(OI为>0.70~0.75)组24眼,重度视盘倾斜(OI≤0.70)组38眼。分析视盘倾斜程度与眼部生物学参数及眼底改变的关系。结果 无视盘倾斜组、轻度视盘倾斜组、中度视盘倾斜组和重度视盘倾斜组患眼的眼压、角膜厚度、前房深度比较差异均无统计学意义(均为P>0.05),4组患眼间最佳矫正视力、等效球镜度、眼轴长度、黄斑中心凹下脉络膜厚度及眼底黄斑病变的发生率比较差异均有统计学意义(均为P=0.000)。随着视盘倾斜程度加重,HM眼呈现出最佳矫正视力更差、等效球镜度更大、眼轴长度更长、黄斑中心凹下脉络膜厚度更薄、更易合并眼底黄斑病变的趋势。有视盘旋转的HM眼底黄斑病变的发生率为24.39%,低于无视盘旋转的HM眼底黄斑病变的发生率43.04%,差异有统计学意义(P=0.044)。结论 大多数HM眼存在着不同程度的视盘倾斜,且随着视盘倾斜程度的加重,患眼病变程度越重。视盘倾斜可作为评估HM发展的要素之一。

Objective To analyze the clinical characteristics of patients with high myopia(HM) combined with different degrees of optic disc tilt. Methods A cross-sectional study was carried out. A total of 60 patients(120 eyes) with high myopia who visited the Hospital of Chengdu University of TCM from April to December 2021 were included. They were divided into 4 groups according to the ovality index(OI) of the optic disc. There were 31 eyes in the non-optic disc tilt group(OI>0.80), 27 eyes in the mild optic disc tilt group(OI>0.75-0.80), 24 eyes in the moderate optic disc tilt group(OI>0.70-0.75) and 38 eyes in the severe optic disc tilt group(OI≤0.70). The relationship between degrees of optic disc tilt and ocular biological parameters and fundus changes was analyzed. Results There was no statistically significant difference in intraocular pressure, corneal thickness, and anterior chamber depth among the four groups(all P>0.05), but significant differences in best corrected visual acuity(BCVA), spherical equivalent, axial length, subfoveal choroidal thickness, and incidence rate of fundus macular degeneration(all P=0.000). With the aggravation of optic disc tilt, HM eyes showed worse BCVA, greater spherical equivalent, longer axial length, and thinner subfoveal choroidal thickness, and were more prone to fundus macular degeneration. The incidence rate of fundus macular degeneration in the HM eyes with optic disc rotation was 24.39%, which is lower than that of HM eyes without optic disc rotation(43.04%), showing a significant difference(P=0.044). Conclusion The data of this study show that most HM patients have different degrees of optic disc tilt, and the severity of eye degeneration is aggravated with the deterioration of optic disc tilt. Optic disc tilt can be used as one factor to evaluate the development of HM.